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Mental Health problems in the elderly \| Dementia \| Anxiety \| Depression

Common Mental Health Problems in the Elderly

Many people live a long and happy life without any mental health issues, and despite the all too prevalent image of elderly people being slow and forgetful, dementia isn't an inevitable development as we age.

There are many reasons why mental health problems can increase with age, from biological changes which can interfere with the brain's ability to process information, to social changes such as retirement and children leaving home which can lead to feelings of isolation or worthlessness. Underlying diseases such as stroke or Parkinson's which are more common with age are often important contributory factors.

Mental health problems can have a serious impact on an older person's ability to carry out many of the basic activities of daily living (from getting up, washing and dressing, to shopping and cooking, getting adequate exercise and managing financial affairs). The impact on their quality of life, even from minor symptoms, can be huge.

But problems often go undiagnosed and untreated – low mood may be dismissed as an unavoidable result of the decline from chronic disease that often develops in later years while odd behaviour is too frequently just attributed to eccentricity. Many older people struggle on without the right help – or any help at all.

Understanding why psychiatric illness develops, and how it tends to affect the elderly, is vital in helping people to manage their problems as effectively as possible and reduce the risk of serious harm. An important step is simply getting a diagnosis.

Dementia in the elderly

Dementia is an umbrella term which describes a group of related symptoms, or syndrome, where there's ongoing decline of the brain and its abilities. It increases directly with age, affecting:

About 1.5 per cent of 65 year olds

Six per cent of 75-79 year olds

Over 20 per cent of those over 85

There are more than 100 different types of dementia.

Alzheimer's disease probably accounts for over 50 per cent of cases, and causes the development of protein 'plaques' and 'tangles' within the brain causing the death of brain cells. There's also a shortage of some important neurotransmitters or chemical messengers within the brain.

Vascular dementia is also common, and is often found at the same time as Alzheimer's. This results from atherosclerosis of the blood vessels in the brain which interferes with the blood supply and oxygen delivery to the brain cells.

Other types of dementia include:

Lewy body dementia (which may be a complication of Parkinson's disease)

Fronto-temporal dementia (which particularly affects the frontal lobes, disrupting personality and behaviour)

Wernicke-Korsakoff syndrome (secondary to alcohol abuse)

The exact pattern of symptoms can vary depending on the type of dementia and which parts of the brain are most affected but key problems include:

Difficulty thinking - understanding information, reasoning, planning, or making good judgment on issues

Memory - usually short term memory is lost first and distant memories are better retained

Language - the ability to speak is slowly lost

Mobility, motivation, emotions and behaviour - which typically become erratic

There's no cure for dementia and symptoms will get worse over time. Effective management strategies can help people cope better with symptoms and improve their quality of life. A number of drugs are used to treat dementia – these don't cure or stop the disease but can slow its progress or make symptoms less severe.

More important are tactics to help memory loss (such as a familiar environment and regular routines) and supportive care.

Depression in the elderly

Depression is the most common mental health problem in older people and are regularly an underlying reason why people over 70 visit their GP.

Symptoms may be similar to younger people with depression, such as:

Low mood

Poor sleep

Decreased appetite

Guilt

Self-blame

Loss of motivation or interest in hobbies or a social life

There are symptoms which are more typical in older people; they often don't actually complain of low mood but become anxious, fearful and lacking in confidence. Anxiety is a warning sign for depression in the elderly. Older people may also express their low mood through complaints about physical symptoms – especially pain (which can of course be a cause of depression, so there may be a vicious cycle). Another common symptom of depression in the elderly is confusion or forgetfulness.

Social factors often underlie depression in the elderly, especially loss of a partner or close friends, difficulties getting out to socialise which lead to isolation, and sometimes even boredom after retirement.

As with younger people, treatment consists of a combination of antidepressant drugs and 'talking treatments' such as supportive counselling or forms of psychotherapy (after addressing underlying factors such as pain and isolation for example). It's also important to rule out physical causes of depression such as an underactive thyroid gland which become more common as we age. Occasionally electroconvulsive therapy (ECT) is recommended.

Anxiety in the elderly

Anxiety, panic and phobias disrupt the lives of about one in ten people. Fear is a normal emotion which helps to protect us from danger, but sometimes it becomes out of control and interferes with the ability to do even simple things. As older people already tend to face additional challenges that get in the way of day-to-day living (such as limited strength) the effect of even low levels of anxiety can be very disabling. Anxiety is also often a sign of depression in older people and can amplify the physical symptoms related to low mood, such as pain, palpitations or dizziness.

As with depression, talking treatments can be helpful, especially a treatment called cognitive behavioural therapy which helps a person understand their feelings and learn to react differently to them. Drug treatments, including some which work on both anxiety and depression can also be useful, although tranquilisers should be used with care and limited to brief courses to help through particularly difficult times such as bereavement.

Other common mental health problems in the elderly

Most mental health issues can occur at any age so conditions ranging from bipolar disorder to obsessive compulsive disorder, addiction and less commonly, schizophrenia may develop.

Psychosis – meaning mental illness where there's a loss of contact with reality is common in people in their later years, causing:

Hallucinations

Delusions (abnormal beliefs)

Impaired insight

Psychosis may be caused by:

Many of the conditions already described (especially dementia)

Because of infection, metabolic or hormonal disorders

Substance abuse

Specific psychotic or delusional disorders

Research has suggested that psychosis may trouble up to five per cent of the elderly in the community and much higher numbers in nursing homes.

Help for older people with mental health issues

Once mental health issues have been recognised there are many people who can help. The primary care health team, including GP, nurses and other therapists will often initiate or co-ordinate treatment. But specialist psycho-geriatricians and community mental health teams are also often involved, while families, patient groups such as the Alzheimer's Society, faith groups and many other local resources play a vital part.

Disclaimer

All information taken from BBC Health

All content within BBC Health is provided for general information only, and should not be treated as a substitute for the medical advice of your own doctor or any other health care professional. The BBC is not responsible or liable for any diagnosis made by a user based on the content of the BBC Health website. The BBC is not liable for the contents of any external internet sites listed, nor does it endorse any commercial product or service mentioned or advised on any of the sites.  Always consult your own GP if you're in any way concerned about your health.